Reporting of vertebral fragility fractures: can radiologists help reduce the number of hip fractures?

R M Mitchell,P Jewell,S J Ostlere,D Mckean,M K Javaid

doi:10.1007/s11657-017-0363-y

Abstract

SummaryPatients with osteoporotic vertebral fractures are at increased risk of hip fracture. In a cohort of hip fracture patients, many had previous imaging studies showing incidental vertebral fractures. Fifty-four percent of fractures were not reported by the radiologist, highlighting a missed opportunity for diagnosing and treating osteoporosis, thereby preventing further fractures.PurposePatients with osteoporotic vertebral fragility fractures (VFFs) are at increased risk of future fractures, including hip fractures. Treating osteoporosis in these patients has the potential to reduce the risk of subsequent hip fractures, which are associated with high morbidity, mortality and cost. In this retrospective cohort study, we investigated the reporting and follow-up of VFFs evident on imaging by radiologists at the John Radcliffe Hospital, Oxford.Materials and methodsData from the local Fracture Liaison Service was used to case-find all incident hip fractures from 2013 presenting to the trust. We then identified patients who had also undergone a radiological procedure that included the thoracic and/or lumbar spine in the previous 6 years. All identified radiological images were re-examined for the presence of VFFs using the Genant semi-quantitative method.ResultsSeven hundred and thirty-two patients over the age of 50 with a hip fracture in 2013 were identified. One hundred and fifty-seven patients had previously undergone a radiological procedure involving the spine, and VFFs were identified in 65/157 (41%). Of these, only 30/65 (46%) were reported by a radiologist when the fracture was first visible. 32/35 (91%) of unreported VFFs were from imaging reported by non-musculoskeletal radiologists. Only 16/65 (25%) of patients with a VFF were documented as being on bone-specific therapy at the time of hip fracture.ConclusionsOur study highlights the under-reporting of osteoporotic vertebral fractures, particularly by non-musculoskeletal radiologists. Better systems for reporting and referring osteoporotic VFFs are necessary to increase the number of patients receiving appropriate osteoporosis treatment.

Highlights

Osteoporosis is a systemic skeletal disorder characterised by low bone mass and microarchitectural deterioration resulting in an increased bone fragility and susceptibility to fracture [1]
Our study highlights the under-reporting of osteoporotic vertebral fractures, by nonmusculoskeletal radiologists
Better systems for reporting and referring osteoporotic vertebral fragility fractures (VFFs) are necessary to increase the number of patients receiving appropriate osteoporosis treatment

Summary

Introduction

Osteoporosis is a systemic skeletal disorder characterised by low bone mass and microarchitectural deterioration resulting in an increased bone fragility and susceptibility to fracture [1]. Sufferers of osteoporosis are at an increased risk of fracture. One in 2 women and 1 in 5 men over the age of 50 will experience an osteoporotic fragility fracture in their lifetime [2]. Vertebral fragility fractures (VFFs) are the most common osteoporotic fracture [3]. Arch Osteoporos (2017) 12: 71 spinal radiographs, DXA vertebral fracture assessment) or incidentally (opportunistically) from images performed for other clinical indications (e.g. CT, MRI, lateral chest radiograph, abdominal radiograph) [4]. Despite being a common incidental finding on diagnostic imaging, the majority of fractures are asymptomatic [5]. It is well established that individuals with VFFs are at a significantly increased risk of suffering hip fractures and further vertebral fractures [6, 7]. Hip fractures are associated with increased morbidity and mortality, and in the UK account for at least £1.1 billion in hospital costs alone [8, 9]

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